The purpose of new Rule 59G-1.045 is to incorporate by reference Florida Medicaid forms.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.: RULE TITLE:

59G-1.045Medicaid Forms

PURPOSE AND EFFECT: The purpose of new Rule 59G-1.045, F.A.C. is to incorporate by reference Florida Medicaid forms.

SUMMARY: The Medical Certification for Medicaid Long-term Care Services and Patient Transfer Form is used to determine the medical eligibility for Medicaid waiver programs. The Pre-Admission Screen and Resident Review (PASRR) Level I Screen for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID) form is used by state agencies or providers to comply with the screening requirements mandated by Title 42, Code of Federal Regulations, Subpart C, section 483.100-483.138.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905(8), 409.912 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: July 16, 2015, 10:00 a.m. ‒11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, Florida 32308-5407

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Laura Armstrong. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Laura Armstrong, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

Please note that a preliminary draft of the reference material, if available, will be posted prior to the public hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Comments will be received until 5:00 p.m., on July 16, 2015.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-1.045 Medicaid Forms.

(1) The following forms are incorporated by reference and are used either by other state agencies or providers enrolled in or registered with the Florida Medicaid program.

(2) The forms are available from the Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic.

(a) Medical Certification for Medicaid Long-term Care Services and Patient Transfer Form, AHCA Form 5000-3008, ___________

(b) Pre-Admission Screen and Resident Review (PASRR) Level I Screen for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID), AHCA MedServ Form 004 Part A,__________

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905(8), 409.912 FS. History–New _______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Mary McCullough

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 03, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: March 2, 2015